T6 PPTs

Question 1

When should prandial insulin be initiated in patients with type 2 diabetes?

Answer 1

When A1C is above goal, FPG is at target, or basal insulin doses exceed 0.5 IU/kg.

Question 2

What is a key step before initiating prandial insulin?

Answer 2

Assess adherence to basal insulin therapy.

Question 3

What are the rapid-acting insulins used for prandial dosing?

Answer 3

Lispro (Humalog®), Aspart (Novolog®), Glulisine (Apidra®), Lyumjev®, Fiasp®.

Question 4

What is the timing for administering rapid-acting insulin?

Answer 4

Administer within 15 minutes before or immediately after the start of a meal.

Question 5

When should basal insulin therapy be initiated in patients with type 2 diabetes?

Answer 5

When A1C is above target despite dual/triple therapy or when A1C >10%.

Question 6

What is the starting dose of basal insulin for most adults with type 2 diabetes?

Answer 6

10 IU daily or 0.1-0.2 IU/kg/day.

Question 7

What are examples of basal insulin formulations?

Answer 7

Glargine (Lantus®), Detemir (Levemir®), Degludec (Tresiba®), NPH (Humulin N®, Novolin N®).

Question 8

What is the duration of action for Glargine U-100?

Answer 8

22-24 hours.

Question 9

What are the needle lengths typically used for insulin injections?

Answer 9

4-6 mm pen needles; longer needles are not necessary for most patients.

Question 10

What is the benefit of using insulin pens over syringes?

Answer 10

Ease of dosing, shorter needles, and convenience for patients.

Question 11

What is the importance of priming insulin pens before each injection?

Answer 11

Priming ensures accurate dosing and insulin flow before injection.

Question 12

What is the ‘Rule of 5 Mississippis’ in insulin pen injections?

Answer 12

Hold the pen in the skin for 5 seconds after injection to ensure full dose delivery.

Question 13

What are some myths about insulin use?

Answer 13

That insulin is a sign of personal failure or that it causes severe complications.

Question 14

How can patient resistance to insulin therapy be addressed?

Answer 14

By dispelling myths, discussing insulin benefits, and reinforcing that insulin is part of effective diabetes management.

Question 15

Why should insulin injection sites be rotated?

Answer 15

To prevent lipodystrophy and ensure consistent absorption.

Question 16

What regions should be avoided to prevent inadvertent intramuscular insulin delivery?

Answer 16

Limbs and non-truncal areas should be avoided, especially in lean or younger patients.

Question 17

How should prandial insulin be titrated?

Answer 17

Start with 4 IU or 10% of basal dose at one meal, adjust by 1-2 IU or 10-15% twice weekly.

Question 18

What is the main goal of prandial insulin therapy?

Answer 18

To control postprandial glucose excursions after meals.

Question 19

When should premixed insulin regimens be considered?

Answer 19

For patients who prefer fewer injections but need both basal and prandial coverage.

Question 20

How often should basal insulin be adjusted?

Answer 20

Increase by 2 units every 3 days to reach fasting blood glucose target.

Question 21

When should basal insulin doses be reduced?

Answer 21

If fasting glucose is consistently <70 mg/dL or if hypoglycemia occurs.

Question 22

What is the maximum recommended basal insulin dose?

Answer 22

Approximately 0.5 IU/kg/day; beyond this, prandial insulin should be initiated.

Question 23

How should unopened insulin be stored?

Answer 23

In the refrigerator, between 36°F to 46°F (2°C to 8°C).

Question 24

How should opened insulin pens or vials be stored?

Answer 24

At room temperature, but discard after 28 days.

Question 25

Why should insulin not be frozen?

Answer 25

Freezing insulin denatures the protein, rendering it ineffective.

Question 26

What are the advantages of combining basal insulin with GLP-1 receptor agonists?

Answer 26

Improved glucose control with less weight gain and reduced insulin dose.

Question 27

What are examples of combination products with basal insulin and GLP-1 receptor agonists?

Answer 27

Xultophy® (insulin degludec + liraglutide) and Soliqua® (insulin glargine + lixisenatide).

Question 28

What is the target blood glucose level for avoiding hypoglycemia during insulin therapy?

Answer 28

Keep glucose levels above 70 mg/dL.

Question 29

What should patients do if they experience mild hypoglycemia?

Answer 29

Consume 15 grams of fast-acting carbohydrate, check glucose after 15 minutes.

Question 30

What are the most common symptoms of hypoglycemia?

Answer 30

Shakiness, sweating, palpitations, and confusion.

Question 31

How is insulin dosing calculated when starting therapy in type 2 diabetes?

Answer 31

Typically 0.1-0.2 IU/kg/day or 10 IU once daily for basal insulin.

Question 32

What are the benefits of basal insulin over other insulin types?

Answer 32

Less risk of hypoglycemia due to its long-acting and consistent profile.

Question 33

What is the recommended next step if A1C remains above target despite basal insulin titration?

Answer 33

Add prandial insulin or GLP-1 receptor agonist.

Question 34

What is the best way to teach patients about proper insulin injection technique?

Answer 34

Provide hands-on demonstration using an insulin pen or vial/syringe, focusing on injection angle and site rotation.

Question 35

What should patients be educated about regarding insulin timing?

Answer 35

Rapid-acting insulin should be administered just before or immediately after meals.

Question 36

How should patients manage missed insulin doses?

Answer 36

Take the missed dose as soon as remembered unless it is too close to the next dose.

Question 37

What is the impact of weight changes on insulin dosing?

Answer 37

Weight gain often requires increased insulin doses, while weight loss may reduce insulin needs.

Question 38

How is insulin sensitivity affected by illness?

Answer 38

Illness can cause insulin resistance, requiring temporary dose increases.

Question 39

What should be done if a patient is experiencing frequent episodes of hypoglycemia?

Answer 39

Review insulin dose and meal timing, adjust doses as needed.

Question 40

What are the benefits of insulin pens compared to syringes?

Answer 40

Insulin pens provide more accurate dosing, convenience, and easier administration.

Question 41

How often should insulin pen needles be changed?

Answer 41

With every injection to reduce the risk of infection and ensure proper dosing.

Question 42

What are examples of premixed insulin formulations?

Answer 42

70/30 (70% NPH + 30% regular), 75/25 (75% insulin lispro protamine + 25% insulin lispro).

Question 43

When is a premixed insulin regimen appropriate?

Answer 43

For patients who struggle with multiple injections and need both basal and prandial coverage.

Question 44

What factors should be considered when adjusting insulin doses?

Answer 44

Meal patterns, physical activity, weight changes, and glucose levels.

Question 45

What is the benefit of continuous glucose monitoring (CGM) in insulin therapy?

Answer 45

CGM provides real-time glucose data, helping to optimize insulin dosing and reduce hypoglycemia.